The Robert Sinclair Davidson Foundation

If you, or a family member are living with a terminal illness, we are here to help. There are a range of ways we can help you, from providing financial support and grants for the provision of specialist equipment to covering the costs of much needed respite.

If you would like to apply for funding, please compete our online application form below. Once we have received your application, you will be contacted by one of our committee members to discuss your situation in a little more detail.

Application Form

Patient's Name: *

Date Of Birth: *

Medical Condition: *

Prognosis: *

Marital Status: *

Number of dependants (children): *

Address (Line 1): *

Address (Line 2): *

City: *

Postcode: *

Contact Telephone Number: *

Email Address: *

Equipment/Support Required: *

Equipment/Support Total Cost: *

How will this equipment/support benefit the patient/family? *

Supplier(s) Details: *

Have the family any means of part-funding?: *

Have you raised any funds through events, sponsorship, parties, etc.?: *

Family Part Funding Details:

Funds Raised Details:

Have any other charities/organisations been asked to help?: *

Other Charity/Organisations Details:

Occupational Therapist's Name: *

Occupational Therapist's Organisation: *

Occupational Therapist's Email Address: *

Occupational Therapist's Telephone Number: *

Additional Comments

If your application is successful do we have your permission to use your photos for testimonial & publicity literature (web, email, flyers, etc.)? *

How did you hear about The Robert Sinclair Davidson Foundation?: